Abstract
Background
Systemic absorption of eye drops is known to occur via the nasal mucosa, cornea, and conjunctiva. Diffusion of eye drops through the skin is previously unrecognized. Here, two cases are presented in which we observed skin pallor around the eyes after instillation of phenylephrine 2.5% drops. Case 1 A 32-week gestational age premature infant had mydriatic eye drops instilled as part of retinopathy of prematurity screening. Case 2 A term newborn dysmorphic infant underwent fundus examination to rule out ocular pathology. In both cases, discoloration of periorbital skin was observed 45 min following administration of drops.
Conclusion
The risks of percutaneous toxicity must always be considered in children, especially in premature neonates, in whom the epidermal permeability barrier is frequently incompetent. Application of smaller drop size or wiping of overflowed drop from the skin may be useful to decrease the risk of systemic side effects.
References
Chew C, Rahman RA, Shafie SM, Mohamad Z (2005) Comparison of mydriatic regimens used in screening for retinopathy of prematurity in preterm infants with dark irides. J Pediatr Ophthalmol Strabismus 42:166–173
Wilkinson AR, Haines L, Head K, Fielder AR (2009) UK retinopathy of prematurity guideline. Eye (Lond) 23:2137–2139
Chien DS, Homsy JJ, Gluchowski C, Tang-Liu DD (1990) Corneal and conjunctival/scleral penetration of p-aminoclonidine, AGN 190342, and clonidine in rabbit eyes. Curr Eye Res 9:1051–1059
Shwayder T, Akland T (2005) Neonatal skin barrier: structure, function, and disorders. Dermatol Ther 18:87–103
Kalia YN, Nonato LB, Lund CH, Guy RH (1998) Development of skin barrier function in premature infants. J Invest Dermatol 111:320–326
Mancini AJ (2004) Skin. Pediatrics 113:1114–1119
Sekkat N, Kalia YN, Guy RH (2004) Development of an in vitro model for premature neonatal skin: biophysical characterization using transepidermal water loss. J Pharm Sci 93:2936–2940
Shell JW (1982) Pharmacokinetics of topically applied ophthalmic drugs. Surv Ophthalmol 26:207–218
Kwon KT, Kazzi AA (2002) Second place winner. Absorption of topical ophthalmic medications presenting as lethargy and apnea in an infant. J Emerg Med 23:371–374
Rush R, Rush S, Nicolau J, Chapman K, Naqvi M (2004) Systemic manifestations in response to mydriasis and physical examination during screening for retinopathy of prematurity. Retina 24:242–245
Sarici SU, Yurdakok M, Unal S (2001) Acute gastric dilatation complicating the use of mydriatics in a preterm newborn. Pediatr Radiol 31:581–583
Sindel BD, Baker MD, Maisels MJ, Weinstein J (1986) A comparison of the pupillary and cardiovascular effects of various mydriatic agents in preterm infants. J Pediatr Ophthalmol Strabismus 23:273–276
Patel AJ, Simon JW, Hodgetts DJ (2004) Cycloplegic and mydriatic agents for routine ophthalmologic examination: a survey of pediatric ophthalmologists. J AAPOS 8:274–277
Gray C (2006) Systemic toxicity with topical ophthalmic medications in children. Paed Perinat Drug Ther 7:23–29
Ogut MS, Bozkurt N, Ozek E, Birgen H, Kazokoglu H, Ogut M (1996) Effects and side effects of mydriatic eyedrops in neonates. Eur J Ophthalmol 6:192–196
Hardman JG, Gilman AG, Limbird LE (1996) Goodman & Gilman's The pharmacological basis of therapeutics, 9th edn. McGraw Hill, New York, pp 529–531
Lawrenson JG, Birhah R, Murphy PJ (2005) Tear-film lipid layer morphology and corneal sensation in the development of blinking in neonates and infants. J Anat 206:265–270
Elibol O, Alcelik T, Yuksel N, Caglar Y (1997) The influence of drop size of cyclopentolate, phenylephrine and tropicamide on pupil dilatation and systemic side effects in infants. Acta Ophthalmol Scand 75:178–180
Isenberg SJ (1994) Physical and refractive characteristics of the eye at birth and during infancy. In: St.Louis (ed) The eye in infancy, 2nd edn. Mosby, Chicago, pp 36–51
Akman I, Demirel U, Yenice O, Ilerisoy H, Kazokoglu H, Ozek E (2010) Screening criteria for retinopathy of prematurity in developing countries. Eur J Ophthalmol 20:931–937
Ling CS, Fleck BW, Wright E, Anderson C, Laing I (1995) Diode laser treatment for retinopathy of prematurity: structural and functional outcome. Br J Ophthalmol 79:637–641
Brennan R, Gnanaraj L, Cottrell DG (2003) Retinopathy of prematurity in practice. I: Screening for threshold disease. Eye (Lond) 17:183–188
Royal College of Paediatrics & Child Health & Royal College of Opthalmologists (2008) UK retinopathy of prematurity guideline. http://www.rcophth.ac.uk/docs/scientific/Guideline_Retinopathy_of_Prematurity_2008.pdf
Author information
Authors and Affiliations
Corresponding author
Additional information
Authors do not have proprietary interest, and no financial support or grant has been received.
Rights and permissions
About this article
Cite this article
Alpay, A., Ermis, B., Ugurbas, S.C. et al. The local vasoconstriction of infant’s skin following instillation of mydriatic eye drops. Eur J Clin Pharmacol 66, 1161–1164 (2010). https://doi.org/10.1007/s00228-010-0890-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00228-010-0890-6